AB0298 THE RISK OF SULPHA ALLERGY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: M. Higashida-Konishi, K. Izumi, T. Shimada, S. Hama, T. Oshige, H. Oshima, Y. Okano
Journal: Annals of the Rheumatic Diseases (2022)

Background Sulpha drugs have been used such as sulfasalazine for the treatment of rheumatoid arthritis (RA), and trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment or prevention of pneumocystis pneumonia. However, some patients with RA delay treatment because of allergy to sulpha drugs[1]. We reported that 16.7% of RA patients presented drug allergies[2]. It was not clear what is a risk factor for drug allergies in patients with RA. Objectives The aim of this study was to evaluate the clinical features with sulpha allergy in patients with RA. Methods We prospectively examined consecutive patients diagnosed with RA in our hospital from March 2021 to January 2022. The patients with RA met the EULAR/ACR 2010 criteria. We included patients with RA with other rheumatic diseases. A careful allergic history was obtained from patients with RA and physical examination performed. The first analysis was performed on patient baseline laboratory data at diagnosis of patients with RA with or without sulpha allergy. Sulpha allergy (rash, angioedema and anaphylaxis after drug exposure) was allergy to sulfasalazine or TMP-SMX. The second analysis was performed on seven types of allergic reactions: (1) drug allergies other than sulpha drugs (rash, angioedema and anaphylaxis after drug exposure), (2) food allergy (rash, angioedema and anaphylaxis after foods exposure), (3) allergic contact dermatitis such as metals, and other cosmetics, (4) seasonal allergic rhinitis and/or conjunctivitis (AR and/or AC), and AR and/or AC associated with house dust, (5) asthma, and (6) atopic dermatitis. Results There were 513 patients with RA in our study. In the first analysis, 17 patients with sulpha allergy and 496 patients without sulpha drugs were enrolled (Table 1). The median ages (with supha allergy and without sulpha allergy) were 66.0 and 72.0 years old (p=0.40). Females were 82.3% and 77.0%(p=0.4). The median observation period was 97.0 and 69.0 months (p=0.20). Patients with other rheumatic diseases were 11.6 and 6.8% (p=0.34). Table 1. Characteristics of RA patients at diagnosis of RA With sulpha allergy (n = 17) Without sulpha allergy (n = 496) P Female 83.4% 76.9% 0.77 Age, year, y 66.0 (56.0-78.5) 72.0 (60.0-80.0) 0.40 Observation period, m 97.0 (45.5-182.0) 69.0 (31.0-123.8) 0.20 Patients with other rheumatic diseases 11.8% 6.8% 0.34 ANA-positive patients(&gt;1:80) 52.9% 28.2% 0.052 Anti-SSA antibody-positive patients 46.2% 18.2% 0.02 RF-positive patients 40.0% 66.8% 0.049 The RA patients with sulpha allergy had higher positivity rate of anti-nuclear antibody (ANA) (&gt;1:80) (52.9%, 28.2%: p=0.052), higher positivity rate of anti–Sjögren’s-syndrome-related antigen A autoantibody (anti-SSA antibody) than those without sulpha allergies (46.2%, 18.2%: p = 0.02) and lower positivity rate of rheumatoid factor(RF) than those without sulpha allergies (40.0%, 66.8%: p = 0.049). In the second analysis drug allergies other than sulpha allergy were more frequent in patients with sulpha allergy. Drug allergies other than sulpha allergy were such as antibiotics and nonsteroidal anti-inflammatory drugs. There were no significant differences in other allergies. Conclusion Among patients with RA, patients with sulpha allergy had higher positivity rate of ANA and anti-SSA antibody, and lower positivity rate of RF than those without sulpha allergy. RA patients with sulpha allergy had a higher prevalence of the other drug allergies than those other than sulpha allergy. References [1]Konishi MH et al. Allergic diseases in adult-onset Still’s disease and rheumatoid arthtitis. Arerugi. 2021; 70: 965-975. [2]Konishi MH et al. Allergic Disorders and Drug Allergies in Primary Sjögren’s Syndrome and Rheumatoid Arthritis. EULAR 2021. Disclosure of Interests None declared